It is one thing to start the therapy process, but another to learn to trust it. Most parents are clearly interested in seeing the results of their investment in the therapy. Therefore, it is very important to understand how to evaluate progress, to allow parents to recognise what they are paying for and to allow the child to reach the targets as fast as he is able to.
To accomplish the targets both child and parents are looking for, a sufficient coordination between motor control, cognition, and emotional processing needs to develop. Such integration brings optimum functioning and contributes to the development of learning, concentration and social skills.
Like the parents, I too am interested in addressing the reasons for the referral. Evaluating progress can be looked at from different angles. Before the child reaches the final targets, we can gain an insight into the impact the exercises have on the child’s body, emotions and cognition:
On the physical level, I am monitoring the child’s progress; the length of time he takes to perform each exercise and the quality of his movements, i.e. how well he is able to isolate different muscle groups without tension developing in his body throughout the exercises. (3 sub-levels are described below)
On an emotional level, I am looking at: the development of his information processing, i.e. his capacity to tolerate frustration, his ability to make transitions from his emotions to his cognition and vice versa, the capacity to regulate feelings and the development of self-reflection. I also monitor changes in ability to express or contain feelings.
On the cognitive level,I am looking at the development of sentence structuring; compartmentalisation of thought; the way thought is expressed and how well the child can hold those thoughts in a conversation.
As therapy progresses, there may be a constant fluctuation in these different areas, and sometimes it may look as if the child is regressing. It’s very important to understand that in most circumstances the brain cannot process new information and use it at the same time. So, while the child’s brain takes in the new, and develops his physical abilities, he displays the pressure he feels in different subtle ways, which we need to observe and respect.
The reasons for that are: when the brain gets a daily input of exercises it ‘reminds’ him of how uncoordinated the different muscle groups are, while it alerts the ‘survival mechanism’, which, in turn, could increase a sense of insecurity. This can trigger, temporarily, anxiety, restlessness or a sense of fragmentation. So it’s important to monitor the child’s exercising programme weekly to allow him to develop at his own pace – and not that of his parents or teachers’.
If the child’s starting point is one of obvious underdeveloped coordination for his age, then soon a significant, and welcome, development will take place, where the child will improve the connection of his two brain hemispheres, via gross and fine motor exercises.
Sometimes, the progress is difficult to assess, as each child has his own personality and one observes different phases of the impact the exercises have.
Physically, progress takes place on 3 sub-levels:
1. Managing to perform an exercise correctly.
2. Performing the exercises skilfully.
3. Managing to perform an exercise, whilst doing something else, i.e. tapping fingers while blinking and breathing, answering questions continuously without tension accumulating in the body, therefore – multitasking.
Improvement while moving towards results, may be visible while the child is progressing through the different sublevels. The longer the child was exposed to academic work he struggled with (and, as a result, accumulated frustration), the longer it may take his brain to adjust to the body’s new coordination abilities, as well as developing self-belief.
It is of great importance to pay attention to even the most subtle changes as they emerge. Notice changes in: frequency, intensity and duration of different bodily behaviour; how does your child handle his anxiety in social interaction? How does he respond to losing in a game? What’s different in the way he is doing his homework, his reading, writing or mathematics? Are there any changes in the level of tension in his body? How does he show his needs? Is he able to stand his ground more? Does he look more secure, confident or aware of his body?
It is always very useful to go back to the detailed pre-assessment questionnaire and look at your answers in relation to what you would have written if you were asked at this point, as a way to compare.
Mrs. J wrote me a short email about her son’s progress a few months into his therapy:
“N has made amazing progress; I watched him handle a stroppy girl yesterday (believe me, a real spoilt drama queen!).I was in a group with N and 4 boys, and they were hungry so I bought them each a croissant in the museum. Later, when this girl heard of it, she said “how come?” So N said “I don’t know, I guess my mum is nice. So this girl said “MY mum is the head of OUR group. So, you’re saying my mum’s NOT nice. You’re a pig and I’m telling her.” N came running to me, panicked. I told him “Just explain yourself. You did nothing wrong. He said to that girl; “you know, my mum is nice and your mum is nice too. Maybe you can get a croissant next time.” She then replied; “I’m still telling my mum on you, pig!” N said “do whatever you have to” and walked away. Doesn’t sound so dramatic- you had to be there, but last year he would have cried, or told her she was not only a bigger, fatter pig, but ugly too…..I think its progress.”
Finally, it is of great interest to both a child’s parents and myself to meet up after 3-4 months of weekly sessions, to look at the impact the programme has had on both the child and his parents, and to decide how to move forward, with the C.Q. therapy.
© Myrom Kahaner